“We want to relieve the burden on family doctors”

Fifteen percent of people in Switzerland have a moderate to high level of stress, according to the 2019 health report issued by the Swiss Federal Statistical Office. For Birgit Watzke of the UZH Department of Psychology, that is “in itself not a greatly alarming number” – after all, not every situation that causes stress in the short or medium term leads to a psychological disorder.

For the professor of clinical psychology, the alarm bells ring if the stress or problem begins to cause physical or psychological difficulties. “There is a definite structural gap in our health system at this point. Diagnostic assessments by the basic health provider, that is the general practitioners or family doctors, happen too seldom or too late. Even if an appropriate diagnosis is made, treatment is often insufficient and is not state of the art.”

Provision of care in mental health

Watzke has spent years looking into what kind of care is provided for the most common mental health problems – depression, addictions, somatic symptom disorders and anxiety disorders. Her findings are unfortunately less than positive. There are frequently gaps in the system, which mean people going through stressful or difficult circumstances do not even make it into any kind of treatment system.

This may be because their GP does not recognize the problem early enough or does not see any need for specialist treatment, or because waiting lists for specialists are too long. Or the wrong kind of treatment may be given, for example prescribing psychotropic medication too quickly instead of psychotherapy. “Studies show that, in Switzerland, only one in three people with a mental health problem receive appropriate specialist care.” There is ample evidence that such failings in care can lead to far-reaching health impairments, chronic disorders and high costs for the health system.

Birgit Watzke sees the situation, which is clearly unsatisfactory for all concerned, from two angles – alongside being a researcher and professor, she is a practicing psychotherapist. As a researcher, Watzke looks for new ways to make traditional psychotherapy approaches more flexible, for example by making therapy options available that are tailored as much as possible to the patient’s needs.

She also conducts efficacy studies to find out which innovative, low-threshold therapy options show promising results, for example online therapy services, telephone psychotherapy and self-help programs. Watzke also tests models for more efficient collaboration between primary and secondary caregivers, i.e. between family physicians and other therapists involved in the patient’s care. As a psychologist, Watzke tries out new counseling approaches or tests self-help methods in consultation with her own patients.

Low-threshold services

One of the units within Watzke’s professorial chair is the Psychotherapy Outpatient Center. Anyone worried about their mental health can contact the center directly, without referral, for diagnosis, evaluation, advice and treatment. One particularly low-threshold service is the weekly walk-in session where people can drop in without an appointment for an initial chat to discuss their situation.

In addition, the “Fachstelle Psychische Gesundheit” (mental health expert unit) has belonged to Watzke’s chair since November 2019. “The unit is directly aimed at GPs and is intended as a first point of call to assist them in finding the right treatment for patients with mental health problems. The doctors have the option, for example, of sending their patients to us for a diagnostic evaluation consultation.” Integrated care and collaborative care are key concepts for Watzke’s approach.

When Watzke did her undergraduate studies at the University of Bielefeld, her interest initially lay in neuropsychology. It was only later that she found her way to clinical psychology, a profession she now appreciates for its two intertwined branches, the conceptual development of research questions and their implementation in studies, and the therapeutic work with patients.

Watzke’s varied experience makes it easier for her to work at the interface between academia and praxis. Bridging this gap – i.e. implementing research findings in real life, as well as feeding back experience from clinical practice into research – is her primary aim, says Watzke. “I am in a privileged position with my career, so I am determined to make a contribution to society and our health system.”